Lisa writes: "I recently came across a diet that’s supposed to help with acid reflux. In this diet, you cut way back on carbohydrates and replace those calories with fat. The theory is that your body sometimes cannot absorb certain carbs, so they sit in your gut and ferment, thereby causing gas to bubble up into the stomach and esophagus. If you cut back on these fermentable carbs, your acid reflux will go away."
The diet that Lisa is asking about is essentially a branded variation of the low FODMAP diet I’ve talked about before. In the low FODMAP diet, you reduce your intake of foods that are high in certain fermentable carbohydrates. It is true that humans lack the enzymes needed to digest certain carbohydrates. That doesn’t cause them to "sit in your gut." They travel through the stomach (which is far too acidic to allow any fermentation to take place), enter the small intestine (where most carbohydrate digestion and absorption takes place), and then on into the large intestine.
There, if you’re lucky, the beneficial bacteria in your gut will digest them by fermenting them. I say "if you’re lucky" because this bacterial processing of indigestible fibers produces several beneficial compounds, which I talked about in my recent episode on Postbiotics. The fermentation of fiber also produces gas. Lots and lots of gas.
See also: Got Gas?
People vary in their ability to tolerate these fermentable carbs. Many people with IBS get great relief from a low-FODMAP diet and the latest research suggests that this is a very effective therapy for disorders that involve the large intestine.
Reflux, on the other hand, happens at the other end of the digestive tract. There's about 20 feet of small intestine between the large intestine, where the bacteria do their work, and the esophagus, where reflux symptoms are generally experienced. It’s a little hard to imagine those gas bubbles working their way six meters upstream to your esophagus, especially when there is a much shorter path to the outside world, if you follow my meaning.
But what if a bunch of those carbohydrate-digesting, gas-producing bacteria were hanging out in the small intestine, instead of in the large intestine where they belong? That would potentially put those gas producers in closer proximity to the stomach. And this does happen. It’s known as SIBO (Small Intestine Bacterial Overgrowth) and may affect up to 15% of the population.
If you’re one of those in the 15%, reducing your intake of fermentable carbohydrates could reduce the amount of gas produced in your small intestine and this could potentially reduce reflux symptoms. If you’re in the other 85% of the population, it’s still possible that reducing these carbohydrates could alleviate symptoms for some other reason that we haven’t thought of.
And this is where I would usually say: "It’s worth a try! If it helps alleviate your symptoms and doesn’t do any harm, then it doesn’t really matter why it works, does it?" Better is better.
But now, let me quote the rest of Lisa’s email:
"I've been trying it for about three weeks and it hasn't helped yet. At the same time, my energy level during strenuous exercise (hiking and biking long distances) is awful; I just feel so weak and tired. Is it reasonable to eliminate effects of acid reflux AND maintain energy for exercise using this method?"
It is possible to train your body to convert fat more efficiently into fuel during exercise. This is sometimes referred to as being "keto-adapted" or "fat-adapted." However, athletes who follow low-carb diets for an extended period of time become less able to utilize carbohydrates as fuel. There may be advantages to maintaining metabolic flexibility, which I talked about in my episode Carbs or Fat: Which is the Body’s Preferred Fuel Source?.
But if the approach isn’t reducing your reflux symptoms, this may be a moot point.
It takes about six to eight hours for food to move through the stomach and small intestines. Once it hits the large intestine, things slow down considerably. It can take anywhere from one to three days for that material to move through the final meter and a half of large intestine. (Considerably less if you’re suffering from diarrhea).
Three weeks of limiting carbohydrates should be more than enough time to see an effect. In Lisa’s case, the approach isn’t reducing her symptoms and seems to be having a negative effect on her energy and stamina. I’d say it’s time to bail on this test.
Unfortunately, reflux symptoms are usually treated with acid-reducing drugs which, ironically, can make both reflux and SIBO worse. For some tips on other approaches, please see my episode on how to avoid acid reflux as well as this surprising reflux tip.
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